Standardization of care for pediatric perforated appendicitis improves outcomes

Yousef, Yasmine; Youssef, Fouad; Homsy, Michael; Dinh, Trish; Pandya, Kartikey; Stagg, Hayden W.; Baird, Robert; Laberge, Jean-Martin; Poenaru, Dan; Puligandla, Pramod; Shaw, Kenneth; Emil, Sherif

doi:10.1016/j.jpedsurg.2017.08.054

Cited by 37 publications

(40 citation statements)

References 23 publications

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“…A significant reduction in LOS was achieved in eight studies (Table S4). Importantly, in all but one study these outcomes occurred with either comparable or improved rates of complication or readmission . Yousef et al and Willis et al notably reported reductions in intra‐abdominal abscess rate by approximately half.…”

Section: Resultsmentioning

confidence: 85%

“…Time without fever was one of the most common discharge criteria. The required period without fever ranged between 12 and 72 hours . Only one small underpowered study explicitly excluded a body temperature value from their discharge criteria, with comparable complication rates and LOS reported .…”

Section: Resultsmentioning

confidence: 99%

“…Discharge criteria in application of standardized care pathways for complicated appendicitis in children …”

Section: Resultsmentioning

confidence: 99%

“…Standardization of blood test and imaging acquisition was implemented in numerous protocols . Five studies restricted ordering of computed tomography scans to only after the seventh post‐operative day if the child was not meeting discharge criteria, or there was clinical suspicion of an intra‐abdominal abscess .…”

Section: Resultsmentioning

confidence: 99%

“…The required period without fever ranged between 12 and 72 hours. [24][25][26][27][28][29][30][31][32][33][34] Only one small underpowered study explicitly excluded a body temperature value from their discharge criteria, with comparable complication rates and LOS reported. 35 The importance of tolerating oral intake of fluid or solid diet, and adequate oral analgesia was heavily emphasized in many studies.…”

Section: Complicated Appendicitismentioning

confidence: 99%

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Fast‐track surgery for acute appendicitis in children: a systematic review of protocol‐based care

Do‐Wyeld

Rogerson

Court‐Kowalski

et al. 2019

ANZ Journal of Surgery

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Background ‘Fast‐track’ surgery protocols aim to standardize and rationalize post‐operative care, with evidence of safety and efficacy in both uncomplicated and complicated childhood appendicitis. Generalization for broader adoption has been limited by variation in protocol design, including specific antibiotic choice, discharge criteria, post‐operative monitoring and patient selection. Methods A systematic review of the literature was performed to evaluate the current evidence underpinning fast‐track protocols for childhood appendicitis and identify areas of consensus and controversy. Results About 33 studies met the inclusion criteria, including four prospective observational studies, 20 case–control studies, seven cohort studies and two randomized controlled trials studying uncomplicated (n = 9), complicated (n = 18) and mixed cohorts (n = 6). Reduction in length of hospital stay was almost universally reported, with equivalent or improved complication rates. Key themes of protocols included antibiotic choice and duration, discharge criteria and post‐operative laboratory and radiographic testing. Rationalized analgesia is an underexplored aspect of protocol design, and a standardized definition of complicated appendicitis remains elusive. Conclusion Standardized care of childhood appendicitis has been shown to be safe and effective in several local and international centres. Next steps include investigation of a complicated appendicitis protocol that integrates rationalized analgesia in appendicectomy recovery, and development of a consistent classification scheme for complicated disease to aid in identification of amenable cohorts.

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Section: Resultsmentioning

confidence: 85%

Section: Resultsmentioning

confidence: 99%

“…Discharge criteria in application of standardized care pathways for complicated appendicitis in children …”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Complicated Appendicitismentioning

confidence: 99%

See 3 more Smart Citations

Fast‐track surgery for acute appendicitis in children: a systematic review of protocol‐based care

Do‐Wyeld

Rogerson

Court‐Kowalski

et al. 2019

ANZ Journal of Surgery

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Pediatric Appendicitis Severity in KwaZulu‐Natal, South Africa: A Retrospective Cohort Analysis

et al. 2018

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Variation in Classification and Postoperative Management of Complex Appendicitis: A European Survey

2018

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BackgroundData on common practice in the management of patients with complex appendicitis are scarce, especially for the adult population. Variation in the definition of complex appendicitis, indications for and the type of prolonged antibiotic prophylaxis have not been well studied yet. The aim of this study was to document current practice of the classification and postoperative management of complex appendicitis on an international level.MethodsAn online survey was dispersed among practicing surgeons and surgical residents. Survey questions pertained to the definition of a complex appendicitis, indications for antibiotic prophylaxis after appendectomy, the duration, route of administration and antibiotic agents used.ResultsA total of 137 survey responses were eligible for analysis. Most respondents were from Northern or Western Europe and were specialized in gastrointestinal surgery. Opinion varied substantially regarding the management of appendicitis, in particular for phlegmonous appendicitis with localized pus, gangrenous appendicitis and iatrogenic rupture of appendicitis. The most common duration of postoperative antibiotics was evenly spread over <3, 3, 5 and 7 days. Whereas most respondents indicated a combined intravenous and oral route of administration was common practice, 28% answered a completely intravenous route of administration was standard practice.ConclusionCurrent practice patterns in the classification and postoperative management of complex appendicitis are highly variable.Electronic supplementary materialThe online version of this article (10.1007/s00268-018-4806-4) contains supplementary material, which is available to authorized users.

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Standardization of care for pediatric perforated appendicitis improves outcomes

Cited by 37 publications

References 23 publications

Fast‐track surgery for acute appendicitis in children: a systematic review of protocol‐based care

Fast‐track surgery for acute appendicitis in children: a systematic review of protocol‐based care

Pediatric Appendicitis Severity in KwaZulu‐Natal, South Africa: A Retrospective Cohort Analysis

Variation in Classification and Postoperative Management of Complex Appendicitis: A European Survey

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